Roseman University of Health Sciences

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life.

Abstract Late-life depression is a common condition that, left untreated, exacerbates negative health outcomes. Despite availability of effective psychotherapeutic treatments for depression, few trials have explicitly investigated treatment mechanisms. Engage is a new, brief behavioral psychotherapy for older adults with depression. This secondary data analysis aims to evaluate behavioral activation as a mediator of the relationship between baseline and post-test depression, hypothesizing that behavioral activation would be a mechanism of change for those in the Engage group. Analysis included 92 older adults with depression who participated in the randomized controlled noninferiority trial comparing Engage with Problem Solving Therapy (PST). Depression (measured via the Hamilton Depression Rating Scale; HAM-D) and behavioral activation (measured via the Behavioral Activation for Depression Scale; BADS) were recorded at baseline and 9 week follow up. Participants were an average of 67.5 years old (SD = 6.19), mostly female (70.7%), Non-Hispanic (92.4%), and white (85.9%) . Analyses were conducted in R and utilized the bruceR package for mediation. HAM-D scores improved for both groups (ps < 0.05). Separate mediation analyses in the Engage and PST groups indicated a direct effect between HAM-D scores across time (p < 0.01). Change in BADS was associated with significant decreases in HAM-D across time for both groups. Results suggest that behavioral activation contributes to but does not fully explain change in depressive symptoms during brief psychotherapy for late-life depression. Psychotherapy treatment mechanisms warrant further study in more diverse samples to better understand treatment response.

Background: Timely dental care is essential to prevent complications and preserve natural teeth, yet inefficient referral practices, low reimbursement rates and systemic barriers continue to disproportionately affect Medicaid-enrolled children. This study assessed the appropriateness of root canal therapy (RCT) referrals to a University-based Advanced Education in General Dentistry (AEGD) program and examined diagnostic and treatment characteristics of referred cases. Methods: A retrospective review was conducted of pediatric patients aged 6-17 years who were referred by external dental providers to two AEGD clinics in Nevada, United States, between February and August 2024 for endodontic evaluation of carious permanent teeth. Demographic, tooth-type, pulp-status, and treatment outcome data were analyzed using descriptive statistics, chi-square tests, Kruskal-Wallis comparisons, and multivariable logistic regression models. Results: Among 154 referred patients, 96.8% (n = 149) were Medicaid beneficiaries. A total of 247 teeth were evaluated; 74.1% were molars. Pulp testing showed that 41.3% had healthy pulps and 16.6% had reversible pulpitis, while only 37.2% of teeth required RCT. Age differed significantly across pulp diagnoses (p = 0.0012), and older age independently predicted appropriate referral (adjusted OR = 1.18, 95% CI 1.07-1.31). Gender was not associated with follow-up compliance (p = 0.47). By November 2024, 53.4% of referred teeth had completed treatment, and 9.3% had no follow-up. Conclusions: More than half of the referral teeth did not require RCT, indicating a high rate of potentially avoidable referrals and highlighting gaps in diagnostic confidence and decision-making at the primary care level. Practical Implications: Enhancing diagnostic training and decision support for general dentists, particularly in vital pulp therapy for young permanent teeth, along with improving Medicaid reimbursement and standardizing referral protocols, may reduce inappropriate specialty referrals. In combination with broader policy reforms, these measures can improve system efficiency and expand access to timely, equitable pediatric dental care.

Background: Pre-eclampsia (PE) is a serious pregnancy complication characterized by elevated blood pressure and proteinuria after the 20th week of gestation. It affects about 5–8% of pregnancies globally and is a leading cause of maternal and fetal morbidity and mortality. Objective: This study aimed to assess the impact of serum uric acid, creatinine, and blood urea nitrogen (BUN) levels on fetal outcomes in preeclamptic mothers. It also examined correlations between uric acid and creatinine, and uric acid and BUN Methodology: A cross-sectional comparative study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) involving 86 pregnant women. Participants were divided into normotensive and preeclamptic groups. After obtaining verbal consent, blood samples were collected in a sitting position to measure serum uric acid, creatinine, BUN, and blood pressure. Results: The mean age was 31.8±2.0 years in the normotensive group and 35.3±2.1 years in the preeclamptic group. Gestational age averaged 34.6 ± 2 weeks in normotensive women and 37.2 ± 1.3 weeks in preeclamptic women. Systolic and diastolic blood pressures were significantly higher in the hypertensive group. Serum levels of uric acid, creatinine, and BUN were also elevated in preeclamptic women, showing strong correlations with each other. These elevated markers were linked to poor fetal outcomes.. Conclusion: The study concluded that elevated serum uric acid, creatinine, and BUN levels, along with the uric acid-to-creatinine ratio, are significant predictors of hypertension and adverse fetal outcomes in pre-clamptic pregnancies.